Identifying a Stable and Generalizable Factor Structure of Major Depressive Disorder Across Three Large Longitudinal Cohorts

Authors

Vincent W S Tseng
Jordan A Tharp
Jacob E Reiter
Weston Ferrer
David S Hong
P Murali Doraiswamy
Stefanie Nickels

Language

English

Publication Date

3-1-2024

Journal

Psychiatry Research

DOI

10.1016/j.psychres.2023.115702

PMID

38219346

PMCID

PMC12165323

PubMedCentral® Posted Date

6-13-2025

PubMedCentral® Full Text Version

Author MSS

Abstract

The Patient Health Questionnaire 9 (PHQ-9) is the current standard outpatient screening tool for measuring and tracking the nine symptoms of major depressive disorder (MDD). While the PHQ-9 was originally conceptualized as a unidimensional measure, it has become clear that MDD is not a monolithic construct, as evidenced by high comorbidities with other theoretically distinct diagnoses and common symptom overlap between depression and other diagnoses. Therefore, identifying reliable and temporally stable subfactors of depressive symptoms could allow research and care to be tailored to different depression phenotypes. This study improved on previous factor analysis studies of the PHQ-9 by leveraging samples that were clinical (participants with depression only), large (N = 1483 depressed individuals in total), longitudinal (up to 5 years), and from three diverse (matching racial distribution of the United States) datasets. By refraining from assuming the number of factors or item loadings a priori, and thus utilizing a solely data-driven approach, we identified a ranked list of best-fitting models, with the parsimonious one achieving good model fit across studies at most timepoints (average TLI >= 0.90). This model categorizes the PHQ-9 items into four factors: (1) Affective (Anhedonia + Depressed Mood), (2) Somatic (Sleep + Fatigue + Appetite), (3) Internalizing (Worth/Guilt + Suicidality), (4) Sensorimotor (Concentration + Psychomotor), which may be used to further precision psychiatry by testing factor-specific interventions in research and clinical settings.

Keywords

Humans, Major Depressive Disorder, Surveys and Questionnaires, Patient Health Questionnaire, Anhedonia, Suicidal Ideation, Depression, Depression, Factor analysis, Project baseline health study, PHQ-9

Published Open-Access

yes

Recommended Citation

Tseng, Vincent W S; Tharp, Jordan A; Reiter, Jacob E; et al., "Identifying a Stable and Generalizable Factor Structure of Major Depressive Disorder Across Three Large Longitudinal Cohorts" (2024). Faculty, Staff and Student Publications. 5844.
https://digitalcommons.library.tmc.edu/uthgsbs_docs/5844